Abdominal Flashcards
GORD
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - abnormal reflux of gastric contents which causes mucosal damage, troublesome symptoms and/or complications
Epidemiology - 10-20%
Pathogenesis - some GOR is normal
Presentation - dyspepsia, food regurgitation into mouth, vomiting, abdominal pain, meal related, relieved by antacids, odynophagia
Investigations - GI examination, PPI trial, H.Pylori testing
Differentials - oesophagi’s, infection, duodenal ulcer, gastric ulcer/cancer, non-ulcer dyspepsia, heart pain
Risk Factors - lifestyle vs medical: obesity, smocking, alcohol, hiatus hernia, hyper secretion of gastric acid
Treatment - Acute: 1st line: standard dose PPI + lifestyle changes
On going: 1st line: continued standard dose PPI
2nd line: surgery fir this with good PPI response
Incomplete PPI response: high dose PPI and further testing, nocturnal component add H2 antagonist
Peptic Ulcer:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - distinct breach in mucosal lining of either stomach or duodenum - common in lesser curvature or duodenal cap/ampulla
Epidemiology - 10-15% of adults
Pathogenesis - H.Pylori (80% gastric 95% duodenal), NSAIDs (20% gastric, 5% duodenal)
Presentation - epigastric pain, nausea, bloating, fullness, reflux
Red Flags: anaemia, weightless, anorexia, recent onset, haematemesis, dysphagia
Investigations - GI examination, FBC, fasting serum gastrin, H.Pylori, endoscopy
Differentials - gastritis, GORD, malignancy, cholecystitis, pancreatitis, hepatitis, IBD/IBS, AAA, MI
Risk Factors -
Duodenal: H.Pylori, NSAIDs, steroids, SRI, blood group O, smoking
Gastric: H.Pylori, smoking, NSAIDs, reflux of duodenal contents
Treatment - stop NSAID,
Active Bleeding: endoscopy +/- transfusion, surgical embolisation
No active bleeding H.Pylori negative: PPI + 2nd line: H2 agonist
No active bleeding H.Pylori positive: H.Pylori eradication, 2nd line: alternative regimen, 3rd line: acid suppression therapy
Ongoing: acid suppression therapy - PPI
Acute Upper GI Bleed:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - bleed in upper GI system
Epidemiology - most common in occurrence with gastric/duodenal ulcers
Pathogenesis - peptic ulcer, oesophagi’s, gastritis, oesophageal varies, mallory-weirs syndrome tear
Presentation - haematemesis, malaena, fresh red PR blood, faintness, shock, syncope
Investigations - GI examination, rockall risk score, Glasgow Blatchford bleeding score, FBC, LFT, U&E, clotting, group and save
Differentials - Lower GI bleed
Risk Factors - alcohol abuse, chronic lover disease, NSAID use, H.Pylori, oral steroid use, anticoagulant use
Treatment - determine sites of bleeding, IV fluids, blood transfusion, Endoscopy - antibiotics for suspected vatical haemorrhage
85% of bleeding stops on own
Acute Lower GI Bleed:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - lower GI bleed
Epidemiology - rare
Pathogenesis - usually due to diverticular disease: ischaemic colitis, peptic ulceration, oesophageal varies, gastritis/oesophagitis, mallory-weirs tear
Presentation - fresh PR blood, mixed blood in stool, blood around stool
Investigations - GI examination, proctoscopy, sigmoidoscopy, colonoscopy
Differentials - upper GI bleed
Risk Factors - alcohol abuse, NSAID use, H.Pylori, liver disease
Treatment - most start and stop spontaneously
Crohn’s:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - inflammatory disease transmural granulomatous affecting any part of gut from mouth to anus, 70% terminal ileum
Epidemiology - 10/20 per 100,000
Pathogenesis - genetics, environment, host immune response
Presentation - dependent on area of bowel
Small: pain, weightless, steatorrhoea
Terminal ileum: acute abdomen with right iliac fossa, pain mimicking appendicitis
Colonic: diarrhoea, bleeding, pain related to defecation
Perianal: Anal tags, fissures, fistulae and abscess
Investigations - GI examination, FBC, iron studies, serum vitamin B12 and folate, metabolic panel, CRP, ESR, X-Ray, CT, MRI, stool testing, yersina entercolitica serology, rectal biopsy, colonoscopy
Differentials - infective colitis, IBS, coeliac, diverticulitis, endometriosis, intestinal ischaemia
Risk Factors - genetic, smoking, stress, depression, appendectomy, NSAID
Treatment -
Induction of remission: glucocorticoids 30-60mg prednisolone, enteral nutrition, intriximab anti-TnF
Maintenance of Remission: azathioprine, 6-meroaptopine, methotrexate, mycophenolate
Surgical ressection of bowel - 80% will require at some point
Ulcerative Colitis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - inflammatory disorder of colonic mucosa, never spreads Proxima to ileocoecal valve
Epidemiology - common in smokers
Pathogenesis - familial aggregation of disease, environment, host immune response
Presentation - diarrhoea, faecal urgency with nocturnal dedication, tenesmus, abdominal pain, weight loss, signs of systemic illness
Investigations - GI exam, FBC, LFT, ESR, CRP, plain abdominal radiograph, colonoscopy, flexible sigmoidoscopy, biopsies
Differentials - infective colitis, IBS, coeliac, diverticulitis, endometriosis, intestinal ischaemia
Risk Factors - genetics, smoking, stress, depression
Treatment - lifestyle changes, screening, pain relief: corticosteroids, aminosalicylase/mesalazine
Surgery - curative and eliminates cancer risk
Irritable Bowel Syndrome:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - functional bowel disorder- no demonstrable abnormalities
Epidemiology - most common gastrointestinal disorder, 20-30
Pathogenesis -
IBS D - diarrhoea
IBS C - constipation
IBS A - alternating stool pattern
Pain predominant IBS
IBS PI - post infective
Presentation - abdominal pain, altered bowel habits, morning rush, psychological problems, extra intestinal symptoms
Investigations - GI examination, FBC, Anti iTG, anti-endomysial antibodies, abdo X-Ray, flexible sigmoidoscopy, colonoscopy, stool studies
Differentials - IBD, coeliac, gastroenteritis, colorectal carcinoma
Risk Factors - depression, anxiety, GI infection, abuse: sexual, physical, verbal, pelvic surgery, eating disorder
Treatment - exploration of dietary triggers, dietician referral, antidiarrhoeal: loperamide, codeine
Smooth muscle relaxants: mebeverine hydrochloride, peppermint oil, dicycloverine hydrochloride
Infective Gastroenteritis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - infection of stomach and intestinal tract
Epidemiology - common
Pathogenesis - norvovirus, bacteria or parasitic, salmonella, shigella, campylobacter, staph, c.diff
Presentation - diarrhoea, vomiting, pain, stomach cramps, fever, fatigue
Investigations - GI exam, stool culture and microscopy
Differentials - IBD, IBS, coeliac disease, colorectal cancer, UTI, chest infection in elderly
Risk Factors - poor personal hygiene, lack of sanitation, immunocompromisation, increased age or very young
Treatment - 1st line: hydration, anti motility agents: loperamide, antobiotics if elderly, oral rehydration solutions
Acute Pancreatitis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - acute inflammation of pancreas releasing exocrine enzymes that cause autodigestion of the organ
Epidemiology - 150-420 cases per 1 million
Pathogenesis - I GET SMASHED
Idiopathic
Gallstones
Ethanol Laccotol
Trauma
Steroids
Mumps
Autoimmune
Scorpion strings
Hyperlipidaemia
ERCP
Drugs: azathioprine, diuretics, oestrogens
Presentation - abdominal pain radiating to back
Investigations - GI examination: tenderness, distention and cullens sign, amylase, lipase, CRP, FBC, U&E, LFT, ca, ABG, ultrasound, CXR, contrast spiral CT
Differentials - AAA - ruptured or dissecting
Risk Factors - PRSS1 + SPINK
Treatment - VACCINES
Vital signs
Analgesics
Catheter/calcium gluconate
Cimetidine - H2 receptor
IV access
NBM/nutrition
Emptying gastric contents
Surgery/senior review
Chronic Pancreatitis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - long standing inflammation leading to irreversible damage to the pancreas
Epidemiology - male 4:female 1, median age 51
Pathogenesis - alcohol, smoking, CF, cancer, metabolic disease, gallstones, trauma
Presentation - generalised abdominal pain, superimposed a Ute flares, floating, abdominal cramps, weight loss, jaundice, steatorrhoea, SOB
Investigations - GI examination, , serum amylase+ lipase, LFTs, ultrasound, spiral CT, faecal elastase
Differentials - pancreatic malignancy
Risk Factors - acute pancreatitis
Treatment - lifestyle measures, low fat die, analgesia, pancreatic enzyme supplementation: CREON, diabetes melitus secondary,
Screening: diabetes and osteoporosis
Surgical intervention: pain, narcotic abuse or decreased weight
Gallstones:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - crystalline concretions formed between the gallbladder by accretion of bile components
Epidemiology - 15% of people in adult western world, fair, fat, female, 40, fertile
Pathogenesis - biliary colic, cholecystitis then cholangitis
High cholesterol, bile pigment stones - black, calcium bilirubinate, mixed stones
Presentation - 90% asymptomatic, RUQ pain, jaundice, pain radiating into interscapular region,
Investigations - GI examination, urinalysis, increased CRP, ESR, bilirubin, mild increase in ALP, AST, prothrombin time increases, CXR, ultrasound, ECG
Differentials - peptic ulcer disease, gastritis, IBD, GORD, pancreatitis
Risk Factors - increase age, female, obese, sudden weight loss
Treatment - analgesia, antibiotics, laparoscopic cholecystectomy, post cholecystectomy syndrome, stone dissolution and shock wave
Acute Hepatitis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigation
Differentials
Risk Factors
Treatment
Definition - inflammation of liver caused by infection, medications, toxins, autoimmune disorders
Epidemiology - decreasing in the uk due to vaccination, 5% of HBV carriers
Pathogenesis - RNA viruses, DNA viruses and incomplete RNA viruses
Presentation - Fever, malaise, anorexia, nausea, RUQ pain, jaundice, urticaria
Investigation - GI examination, LFT: increase AST/ALT and bilirubin, viral markers: HBsAg, HbeAg, antibodies to HBcAg
Differentials - drugs, alcohol, autoimmune disorders, cholecystitis, biliary colic
Risk Factors IVDV, alcohol abuse, poor hygiene, travel, sexual promiscuity
Treatment - active immunisations,
Hep C:Weekly peginterferon alpha SC, daily ribavirin
Acute Appendicitis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - sudden inflammation of the appendix, surgical emergency
Epidemiology - 6 % lifetime risk, 10-20 can occur at any time
Pathogenesis - appendix lumen becomes obstructed with faecolith, lymphoid hyperplasia or filariasis worms
Presentation - periumbilical pain localising to RLQ, nausea, vomiting, anorexia, constipation/diarrhoea, pyrexia
Investigations - abdominal examination, FBC, CRP, ultrasound, CT
Differentials - gastroenteritis, intestinal obstruction, diverticulitis, ectopic pregnancy, right uteric colic
Risk Factors - frequent antibiotic users
Treatment - appendectomy, prophylactic antibiotics
Small and Large Bowel Obstruction:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - mechanical or functional obstruction of intestines preventing the normal transit of digestion products, occurs any point distal from duodenum - medical emergency
Epidemiology - crohns disease 25% incidence in small bowel, common in colorectal cancer in large bowel
Pathogenesis -
Mechanical: simple closed loop or strangulated
Functional: paralytic ileus
Presentation - colicy bowel, vomiting, constipation, abdominal distension
Investigations - abdominal examination: mechanical = tinkling bowel sounds, Functional: decreased bowel sounds, X-Ray, CT, colonoscopy, water soluble enema
Differentials - gastroenteritis
Risk Factors - abdominal surgery
Treatment - incomplete small bowel obstruction: fluids, analgesia, electrolyte correction
Large bowel strangulation/obstruction: emergency surgery, stunting
Sigmoid volvulus can be fixed with flexible sigmoidoscopy
Femoral and Inguinal Hernias:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - protrusion of a viscus or part of a viscus through a defect of wall
Epidemiology - inguinal = most common, indirect =more common than direct, femoral common in middle aged to elderly
Pathogenesis - Inguinal: pass through deep inguinal ring - can strangulate
Femoral: bowel enters femoral canal, commonly strangulates
Presentation - swelling in groin, pain, impulse palpable on cough
Investigations - examination based on area of hernia, ultrasound
Differentials - hydrocele, lymph node swelling, abscess, saphena varies, varicocele, undescended testis
Risk Factors - male for inguinal hernias, female for femoral, constipation, chronic cough, urinary obstruction, heavy lifting
Treatment - diet + stop smoking, small inguinal can be left untreated and monitored,
Inguinal: mesh techniques via surgery
Femoral: all repaired due to strangulation risk, ligation and excision of the sac
